RU2322210C2 - Method for fixing fractured finger phalanx bone fragments - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves forming external carcass, introducing wire through the fractured bone fragments with its ends fixed on the external carcass, conducting wires through the fractured bone fragments with fractured zone compression being applied. The external carcass is formed at the level of injured phalanx. Base wire is introduced through injured phalanx base transversely in frontal plane. The ends are bent at right angle some distance far from skin surface. Wire ends are connected to forming rectangular frame. Then, wire is conducted through distal injured phalanx fragment in the same plane in parallel to the base wire. The fractured bone fragments are got together along the axis concurrently doing reposition. The wire is fixed on the frame.

EFFECT: enhanced effectiveness of early stage medical rehabilitation.

11 dwg, 1 tbl

Description

The invention relates to medicine, namely to traumatology, and can be used in the treatment of fresh open fractures of the proximal and middle phalanges of the fingers.

A known intramedullary method of holding knitting needles for fixing bone fragments during fractures of the phalanges of the fingers of the hand (see ZF Nelsin. Emergency surgery of injuries of the hand and fingers. - M .: Medicine. - 1980. - p. 98-107).

The disadvantage of this method is the instability of fixation of fragments due to the mismatch of the diameter of the medullary canal of the phalanx - 4-6 mm and the diameter of the Kirschner needle - 1-2 mm, conducted through the channel, which leads to the secondary displacement of fragments and the formation of a false joint. Unstable fixation of fragments using a knitting needle requires the use of a plaster cast at the same time for a period of 5-6 weeks, which increases the treatment time.

There is a method of fixing bone fragments in fractures of the phalanges of the fingers by means of bone osteosynthesis using metal plates of various modifications (see V.V. Klyuchevsky. Surgery for damage. - Yaroslavl. - 1999. - p. 390-421).

With open fractures, this type of fixation of bone fragments is rarely used due to the high risk of inflammation.

The closest way to the claimed one is the method of fixation of fragments during fractures of the phalanges of the fingers of the hand, including the formation of an external frame of threaded rods, nuts, strips with holes and grooves for installation and fastening of spokes, fixation of fragments along the length of the needles by securing them to the external frame, fixing fragments across the width by applying needles with compression in the fracture zone (see p. RU No. 2137437, IPC ⁶ A61B 17/66).

The disadvantage of this method is the difficulty of forming an external skeleton, consisting of several parts of various design, including strips with holes and grooves for fixing the spokes placed on the bone fragments.

The aim of this invention is to provide an effective, cheap and affordable method for fixing fragments in fresh, open fractures of the proximal and middle phalanges of the fingers in conventional trauma departments, providing early rehabilitation treatment and the convenience of treating a postoperative wound.

The goal is achieved by the fact that in the method of fixation of fragments during fractures of the phalanges of the fingers of the hand, including the formation of the external frame, the fixation of fragments along the length of the needles with its fastening on the external frame, the fixation of the fragments along the width of the needles with compression in the fracture area, the formation of the external frame is carried out at the level of the damaged phalanx by holding the Kirschner base spoke through the base of the damaged phalanx transversely in the frontal plane, bending its ends at right angles and connecting its ends with the formation of a rectangular supporting frame, and the fixation of fragments along the length by applying a spoke with its fastening on the outer frame is carried out at the level of the damaged phalanx.

The use of the design of the knitting needles in the present method for forming the outer frame, which requires a minimum of costs for the acquisition of the tool itself (knitting needles and drills) and does not require special training of specialists, makes the method cheap and affordable for any trauma unit.

The application of knitting needles at the level of damage on one phalanx without affecting neighboring phalanges provides the possibility of movement and early rehabilitation treatment and free access to treat a postoperative wound.

In figures 1, 2 shows the sequence of operations of the method for forming the outer frame.

The figure 3 shows the operation of the method - fixing along the length of the fragments of the middle phalanx of the finger of the finger by holding a thin spoke with its fastening on the outer frame.

In figures 4-6 shows the sequence of operations of the method - fixing fragments in width with compression in the fracture zone by holding thin spokes with an open oblique fracture of the middle phalanx of the finger of the hand.

In figures 7-9 - the same with an open transverse fracture of the middle phalanx of the finger of the hand.

Figure 10 is a photo of the brush of a patient M-ova, 32 years old, after reconstructive treatment of a fracture of the proximal phalanx of the first finger of the left hand of the claimed method.

The figure 11 is a photo of the brush of a patient G-ova, 45 years old, after reconstructive treatment of a fracture of the proximal phalanx of the fourth finger of the left hand of the claimed method.

The method is as follows.

With any type of open fracture (oblique or transverse) at the level of one phalanx of the finger of the hand, the outer frame is formed by holding the Kirschner base spoke 1 with a diameter of 1 mm transverse (Fig. 1) in the frontal plane through the proximal fragment 2 of the phalanx closer to the base, bending its ends under right angle, departing from the skin by 0.5 cm on both sides, and connecting its ends outside the finger with the formation of a supporting rectangular frame 3 (figure 2). Then carry out the fixation of fragments along the length. A thin carpal needle 4 with a diameter of 0.7 cm is passed through the distal fragment 5 of the damaged phalanx in the same plane and strictly parallel to the base needle. Then the fragments are combined along the axis and at the same time they are repositioned and a thin carpal needle is fixed to the parallel-going sides of the support frame (Fig. 3). As a result, a rigid frame is formed, which prevents the displacement of fragments along the length.

Fixation of fragments in width with the provision of compression in the fracture zone is carried out by applying thin spokes, depending on the location and nature of the fracture. When open oblique fracture through the proximal and distal fragments in the same plane with the frame, but perpendicular to the fracture line spend a pair of parallel thin wrist spokes 6 (figure 4). The opposite ends of the spokes Z-shaped bend (figure 5), pull towards each other until it stops and fix to the frame 3 (figure 6), preventing a shift in width and providing compression in the fracture zone.

For transverse and close fractures, fixation of fragments at the junction in the form of a lock using L-shaped curved spokes is used. Osteosynthesis of L-shaped curved spokes is as follows. After reposition, through each fragment at the fracture site, one thin needle 7 is carried out extra-focal at an angle of 45-60 ° to the axis and counter to each other, so that when leaving the bone on the opposite side, the spokes cross at the fracture level (Fig. 7), after which they are attached to the support frame on different sides of the fracture line. At the entrance to the bone, the tail parts of the spokes are L-shaped bent at right angles towards each other, so that they cross (Fig. 8), and are fixed with a certain tension to the opposite side of the support frame 3 also on different sides of the fracture line (Fig.9). Such fixation prevents all types of displacement of bone fragments at the junction due to the formation of an additional frame effect inside the support frame. Stability at the junction of the fragments is not violated with a load of up to 100 N, which is 5 times higher than the physiological load on the phalanx with free movement of the finger.

Example 1

Patient Ms, 32 years old, as a result of an industrial injury received an open fracture of the proximal phalanx of 1 finger of the left hand. On the third day after the injury, under conduction anesthesia, a delayed primary surgical treatment of the wound was performed, an open reposition of fragments of the proximal phalanx of the 1st finger of the left hand, a spokes structure was applied according to the claimed method. Additionally, gypsum immobilization was used for the first 2 weeks, 1 week after the operation, the patient was allowed to perform passive movements in the injured finger. Fixation of fragments is stable. After removing the sutures, additional immobilization was stopped, the patient received a course of exercise therapy. External fixation with a spoke construction lasted 5 weeks. After removal of the construct, reconstructive treatment was carried out for 3 weeks. The result of the treatment is good. The function is fully restored (figure 10).

Example 2

Patient G-s, 45 years old. He was hospitalized a day after domestic injury due to an open fracture of the middle phalanx of the third finger and a closed fracture of the proximal phalanx of the fourth finger of the left hand. On the fifth day, under the guise of antibacterial therapy, under conduction anesthesia, the first finger of the wound of the third finger was performed, an open reposition of fragments of the middle phalanx of the third finger was performed, and a closed reposition of fragments of the proximal phalanx of the fourth finger of the left hand was applied, the spokes structure was applied separately to each damaged segment using the claimed method. Fixation was carried out for 5.5 weeks. After removing the design from the spokes, rehabilitation treatment was carried out for 1 month. The treatment result is satisfactory, the function of the brush is restored (11).

Similarly, in KKB No. 2 of Khabarovsk, 80 people were operated on with open injuries of various fingers at the level of the middle and proximal phalanges, which is clearly presented in the table.

Phalanx FINGERS PROXIMAL AVERAGE TOTAL I 6 - 6 II 8 5 13 III 12 8 twenty IV 12 9 21 V eleven 9 twenty TOTAL 49 31 80

An affordable, cheap, effective way to fix fragments during open fractures of the phalanges of the fingers of the hand, which provides early rehabilitation treatment, will find application in medicine.

Claims (1)

A method of fixing fragments during fractures of the phalanges of the fingers of the hand, including the formation of an external skeleton, passing the knitting needles through the fragments and securing its ends on the external skeleton, conducting the knitting needles through the fragments, providing compression in the fracture zone, characterized in that the external skeleton is formed at the level of the damaged phalanx, carry the base spoke through the base of the damaged phalanx transversely in the frontal plane, bend its ends at right angles, stepping back from the skin, connect the ends of the knitting needles a rectangular frame, then the needle is passed through the distal fragment of the damaged phalanx in the same plane parallel to the base needle, the fragments are aligned along the axis with simultaneous reposition, and the needle is fixed to the frame.

Images